PSORIASIS

Thoughts and practical advice

When psoriasis affects the skin or nails, it interrupts the process of
keratinisation: i.e. the process that gives rise to the thin and compact
stratum corneum of the epidernis, and the compact and transparent laminar
covering of the nails.A compact
stratum corneum is plastic (i.e. it can flex without cracking), whereas one
that is affected by psoriasis is stiff and and subject to cracking upon
movements. A healthy stratum corneum acts as a barrier against harmful external
agents, whereas one that is psoriatic is permeable to everything:
micro-organisms, environmental pollutants, and even water.

NORMAL STRATUM CORNEUM PSORIATIC
STRATUM CORNEUM

NORMAL NAIL PSORIATIC NAIL

All of the above explains why psoriatic skin, regardless of therapeutic
treatments, needs particular care and attention in order to minimise possible
inconveniences in everyday life.

The same goes for the nail plate: when it is healthy, it is compact
and impenetrable; when it is psoriatic, it becomes delaminated and can be
easily penetrated by micro-organisms, dirt and water.

When psoriasis
affects the scalp

Psoriasis often affects the scalp, which may even be the only affected
site.

Scalp psoriasis is particularly irritating and
uncomfortable: it is often itchy,
continuously releases scales that can be seen on one’s clothes, it extends from
the edge of the hairline and is thus visible, and makes people unwilling to
visit a hairdresser.

Scalp
psoriasis is difficult to treat but, if you do not want to use drugs, natural
reducing agents are an alternative.Natural
reducing agents work well in the treatment of scalp psoriasis. The
most widely used are colloidal sulphur (see page 20) and salicylic acid (see
page 20) formulated in evanescent creams without vaseline. [1] The
cream is applied in the evening and massaged in until it is completely
absorbed.

The advantages are:
• it is safe to use
• there is no rebound effect when it is discontinued
• the treatment has no time limits.

The disadvantages are:
• there is a slight smell of sulphur (similar to sulphurous water).

Sea bathing (thalassotherapy) and bathing in sulphurous spa waters have an anti-psoriatic effect on the scalp.

Anyone who is affected by scalp psoriasis should take
particular care over hair washing.

When psoriasis affects
the scalp

Shampoos are mixtures of tensioactive ingredients intended to de-grease
and wash the hair. However, such ingredients are also irritants, particularly
in the case of a psoriatic scalp.

Shampoos medicated with ichthyol sulphonated

Ichthyol sulfonated, a natural reducing agent, can be usefully incorporated in a shampoo to reduce inflammation, itching and scaling.

Shampoos
medicated with mineral tar (coal tar) Coal
tar is a reducing agent that has an
almost immediate capacity to bind to the stratum corneum, are the most
effective but are not marketed in Europe because it is now prohibited to use
coal tar in cosmetics. Look out for shampoos medicated with vegetable tars,
which are marketed but are not efficacious in treating scalp psoriasis. Oil-based shampoos

Finally, there are
oil-based shampoos that are intended to reduce scalp dryness. Once again, the
irritating action of the tensioactive ingredients prevails over the emollient
action of the oils.

In order to have less irritation when washing your hair, try using a cleansing cream instead of a shampoo

The shampoo for psoriasis
When psoriasis affects the scalp, it is mandatory to pay attention at detergents contained in a shampoo. In fact, the majority of detergents has an irritant action when in contact with skin. The shampoo for psoriasis has to contain, besides antipsoriatic active principles, selected ingredients that do not produce irritation (2).

An alternative to shampoo

An alternative to the use of shampoo may be the use of a cleansing cream.

Cleansing creams

Cleansing creams are emulsions made of fats similar to
the cutis held together by tensioactive ingredients. They are used as
substitutes for normal detergents by subjects with problems of dry skin. People
with scalp psoriasis can benefit from using a lauryl sulphate-free washing
cream [3] also to wash their hair because it manages to clean hair as well as
shampoo without causing dryness or irritation. It reduces itching and scaling.

The rules for hair washing are:
• wet the hair
• put the shampoo or the washing cream on the hair
• rinse
• if necessary, cream the hair a second time
• avoid rubbing the scalp with the shampoo or the washing cream
• avoid detaching the scales from the scalp during washing
• dry the hair preferably using a cotton sponge towel
• use a hair dryer only to complete the drying and without directing hot air onto the scalp·

Hair cosmetic treatments
are allowed.

When
psoriasis affects the nails

Nails affected by psoriasis undergo the same
alteration as the stratum corneum.

The laminar plates making the nails become detached
from each other, and the whole nail becomes detached from the ungueal bed. The consequences are that the nail becomes permeable
to external agents such as water, detergents, dirt and micro-organisms. As a result of the delamination, it becomes opaque and
more fragile; as a result of the penetration of dirt or micro-organisms, it
changes colour and takes on different shades of yellow, brown or black.

These changes cause discomfort, particularly if they
affect the finger nails.

Nail psoriasis can modify the plates in an even more
glaring manner:
• vertical growth: i.e. with thickening
• plate loss or erosion.
Nail psoriasis can also cause deformity of the distal
phalanges of the hands and feet.

In addition to
the above-mentioned unaesthetic effects, psoriasis of the nails also causes
function defects and complications. The main functional defect is loss of grip
in the case of a deformed distal phalanx or the loss of an entire plate.

The main functional defect affecting the feet is a
difficulty in walking when the big toenail becomes thickened, interferes with
shoe uppers, and causes pain.

One
complication that affects both hands and
feet is perionyxis: i.e. infection of the tissue around
the nail. This occurs because the cuticles do
not form and the perionychia becomes permeable to water,detergents, dirt and
micro-organisms.

1) Locally applied drugs have
little effect on the course of nail psoriasis and are therefore of little help
to patients. This is because the alterations in psoriatic nails are due to an
alteration in the ungueal matrix. The matrix is located deeply, above the
phalangeal bone, and can hardly be reached by drugs applied to the skin. As
drugs are not effective, it is better to use natural reducing agents. Both
sulphur and salicylic acid have considerable affinity for nails and
peri-ungueal corneum tissue, and exert a reducing, antimicrobial and
exfoliative action. Although it does not have any real therapeutic effect on
nail psoriasis, vaseline-free, evanescent sulphur-salicylic cream [1]
contributes to softening the laminar plate, facilitating the detachment of the
accumulated scales underneath the nails, and protecting both the nail and
perionychium from infections. Sulphur-salicylic cream [1] is applied once a day
in small amounts, beginning the massage from the free border, then on the nail
and finally the perionychium. The duration of treatment is unlimited.

2) It is known that exposure to the sun during
the summer tends to lead to the regression of the nail damage caused by psoriasis. In order to improve the
nails, the exposure does not have to be prolonged; the light energy of the
summer is sufficient and so, if the affected nails are on the feet, it is
advisable to wear sandals that allow the light to reach the toes. On the
contrary, UV lamps are not very practical because, in order to obtain a
positive result, it is necessary to attend a large number of sessions and, in the
end, there is a risk of inducing damage caused by the UV rays

3) To wash hands and feet
whose nails are affected by psoriasis, it is better to use a cleansing cream
free of lauryl sulphate [3] instead of soap, and to wash them briefly and
infrequently in order to avoid soaking the tissue and worsening the psoriasis.

4) In order to eliminate
the longitudinal streaks, depressions and opacity, and improve the look of the
nails, a professional nail-file should be used; there are some on the market
coated with sapphire that are particularly efficient.

5) If the nail tends to grow vertically in an exaggerated manner, it is not possible
to use a nail-file but necessary to consult a podologist. Podologists have
special high-rotation, water-cooled files of various makes, which are capable
of remodelling both the thickness and free border of the nail plate.

6) In addition to the above treatments, it is possible
to try to hide the nail. The most common way (conventionally reserved for
women) is to use nail varnish. In order to ensure a good result, it is
necessary to file the nails using a standard or rotating nail-file before
applying the varnish, which is better if it is dark and opaque.

7) However, when the nail is severely damaged by
psoriasis, varnish is not enough and it is necessary to construct an artificial
nail made of liquid resins that harden when they are heated or exposed to UV
rays. Once hardened, a nail shape can be cut out.

In addition to
its aesthetic function, the application of a resin nail also serves to keep the
ungueal bed flat, otherwise the distal phalanx would tend to curve upwards
obstructing the growth of the mail itself. If this happens to the big toe, it
can cause pain on walking because of the opposition between the pulp of the toe
and the edge of the nail.

When
psoriasis affects the body

Psoriasis affects the body in various forms and in
various areas; the most common form is
plaque psoriasis, which mainly affects the elbows, knees and sacral region.

However, psoriasis can present polymorphously:

• as a single patch or plaque

• as small but grouped plaques

• as even smaller and disseminated plaques
(drop-shaped)

• as large plaques in abstract configurations.

If we look at a psoriatic plaque through a magnifying
glass, we can see an inflammatory base covered by scales, some of which are
adhering to the skin, some are raised, and some already detached. The whole
forms microfissures that intermingle with each other.

• Once dried, the plaque should be treated with a
polyethylene glycol (PEG) or polydecene (D) ointment – so-called Emollient Ointment – Extreme - [4]
that are simultaneously capable of absorbing residual dampness,
reducing bacterial growth, restoring flexibility to the stratum corneum, and
favouring the detachment of the scales.
• This plaque
begins to lack the flexibility typical of the compact stratum corneum, and so
every movement leads to the creation of a new microfissure.
• The altered barrier function allows the penetration
of water, detergents, dirt and micro-organisms.
• The inflammatory state of the plaque bears witness
to the stress undergone by the living cells that are no longer protected by a
compact stratum corneum. In their everyday lives, psoriatic patients have to
ensure that the plaque does not suffer further stress, and one of the most
difficult moments is when washing because both water and detergents penetrate
and remain in the microfissures and beneath the partially raised scales.

These are the considerations leading to the following
rules for everyday washing:

• A shower is better than a bath because contact between
the water and the plaques is shorter and the scales absorb less.
• Common soaps and detergents should be replaced by a
cleansing cream [3] in order to minimise the irritation of the plaque by
tensioactive ingredients.

After washing, it is necessary to dry the plaques
carefully in order to remove as much water as possible because dampness favours
bacterial growth, which leads to further plaque irritation.

When the psoriasis is minimal and it is wanted to
avoid having recourse to drugs, or in the intervals between drug treatments, or
when drugs are contraindicated or have failed to lead to satisfactory results,
it is possible to use natural reducing agents. These are natural active
ingredients which, when applied to the skin, reduce psoriatic growth. There are
many of these, but the most widely used and the ones for which there is the
greatest amount of clinical documentation are:

• sulphur; • salicylic acid; • ichthyol sulphonate; • mineral tar

Sulphur is the oldest anti-psoriatic natural active
ingredient. It is known to be rich in keratines, the proteins of the stratum
corneum, but it is not known exactly how it is capable of controlling
inflammatory states such as seborrhoic dermatitis and psoriasis. Sulphur-based
pastes or sulphurous water baths have been used to treat skin conditions and
psoriasis since ancient times.

Salicylic acid, which was initially extracted from the bark of
willow trees, has been used since ancient times because of its curative properties.
On the skin, it has an antiseptic, antifungal, keratolytic and reducing action.

The combination of sulphur and salicylic acid Although chemically very different, sulphur and
salicylic acid have similar dermatological curative properties that potentiate
each other, which is why they are used together in what is known as sulphur
salicylic cream

The sulphur salicylic cream used as a reducing agent
in seborrhoic dermatitis and psoriasis must contain sulphur in its colloidal
form and be devoid of vaseline [1]. The concentration of the two active
ingredients must not be more than 2%. This cream leads to good results in
psoriasis affecting the scalp or delicate areas such as the ears, genitals,
nails, etc

Ichthyol
sulphonate is a
compound that first formed 200 million years from marine sediments, and is
today extracted from mines in France and the Tyrol. It is a dense and dark
liquid with a characteristic smoky odour that has antiseptic, anti-inflammatory
and anti-pruritic properties. In psoriasis, it is used in the form of a cream
[5] above all on inflamed and itchy areas. It can be used together with other
natural reducing agents, or alternated with them.

Mineral tar (commonly known as coal tar) is derived from the
distillation of fossil carbon. It is a highly viscous liquid with a
characteristic penetrating smell, and is used in an evanescent cream at a
concentration of 4% [6]. The potent psoriasis-reducing action of 4% coal tar
cream is as active or even more active than cortisone, but there are some
drawbacks. It cannot be used on the scalp because it interacts with hair and
turns it violet; it is not very well tolerated in delicate areas such as the
face and genitals; it has an intense smell; it indelibly stains clothing; and
it acts as a potent photosensitiser because it reacts with sunlight. For this
last reason, it is only used in the winter.

• Suggestions for
treatment with natural reducing agents

Reducing
Agent

When applied

Where applied

Limitations

Positive
association

Sulphur
salicylic cream (1)

Evening

Everywhere

None

Exposure to
sunlight

Ichthyol
sulphonate (5)

Evening

Everywhere

None

Exposure to
sunlight

Coal Tar
Cream (6)

Evening

On body,

not scalp or
delicate parts

NO exposure
to sunlight or UV lamps

-

• Timing and
possible variations – reducing + scaling regimens

No.1

No.2

No.3

Evening

Sulphur salicylic cream (1)

Coal Tar Cream (6)

Ichthyol sulphonate (5)

Morning

Shower with Cleansing Cream (3)

Shower with Cleansing Cream (3)

Shower with Cleansing Cream (3)

After washing

Emollient Ointment –Extreme (4)

Emollient Ointment –Extreme (4)

Emollient Ointment –Extreme (4)

• Timing and possible variations – double
reducing regimens

No.1

No.2

Evening

Coal Tar
Cream (6)

Ichthyol
sulphonate (5)

Morning

Shower with
Cleansing Cream (3)

Shower with
Cleansing Cream (3)

After washing

Sulphur
salicylic cream (1)

Sulphur
salicylic cream (1)

When psoriasis affects the hands and feet

Psoriasis sometimes preferentially or exclusively
affects the palms of the hands, the soles of the feet, or both locations.

PALMAR PSORIASIS PLANTAR PSORIASIS PALMO-PLANTAR PSORIASIS

Palmo-plantar psoriasis has various clinical forms,
the most frequent of which are erythematous, hyperkeratotic, exfoliative and
dyshidrotic psoriasis

ERYTHEMATOUS
FORM

HYPERKERATOTIC FORM EXFOLIATIIVE FORM DYSHIDROTIC FORM

When
psoriasis affects the hands and feet

When psoriasis affects the palms and soles, it creates
new management problems because one of the characteristics of even the mildest
forms of palmo-plantar psoriasis is the presence of cracks or rhagades. This is
due to the fact that a poorly organised stratum corneum can never have the
necessary elasticity to cope with the movements of the hands and feet. The cracking may be clearly visible or not, as in the
case of the microfissures or microrhagades in the examples below.

When
cortisone treatment is prescribed

Cortisone is still the most widely used drug for the
treatment of localised (particularly palma-plantar) psoriasis. Unfortunately, cortisone is the least suitable drug
for treating a chronic dermatitis such as psoriasis because of its known
unwanted effects of tachyphylaxis and rebound.

Tachyphylaxis is a form of desensitisation over time that means
an increasing amount of drug has to be administered in order to obtain the same
therapeutic result.

In the case of psoriasis, this means starting to
control the disorder by applying cortisone once a week, but then having to
apply it everyday or more than once a day, and sometimes still being unable to
control it.

Rebound is the term used to describe the fact that,
when cortisone is stopped, the dermatitis markedly worsens. In the case of palmo-plantar
psoriasis, stopping cortisone leads to swelling, burning, the opening of the
cracks, and the appearance of blisters or blebs.

Controlling rebound after the discontinuation of
cortisone is particularly difficult,
and often exposes the patient to considerable suffering. For this reason,
before stopping the drug, it is necessary to justify the need to do so.

Psoriasis is an inflammatory state of the skin, and
worsens in the presence of other stimuli of cutaneous inflammation. In other
words, it must be soothed and not stimulated. When it affects the hands and
feet, it is particularly difficult not to cause further stress on the skin: it
is enough to think of walking and the everyday handling of common objects. The
philosophy of “placating” palmo-plantar psoriasis therefore involves
eliminating as many pro-inflammatory stimuli as possible. The most important of
these is contact with water and detergents. Water is itself an irritant of the
psoriatic state: it can penetrate between the scales and in the cracks, making
them damp and thus favouring microbial growth and the consequent irritation.
The tensioactive ingredients in detergents are further pro-inflammatory stimuli
that psoriatic skin needs protecting against. Even dust causes irritation and
needs to be kept away from the skin.

Wash without getting your hands and feet wet. The idea
is to prevent water and detergents from coming into contact with psoriatic
skin. In the case of the hands, the recommendation is to wear vinyl gloves [7],
which are impermeable to water and do not irritate the skin themselves.

However, they do not adhere to the wrists, and so it
necessary to take care that water does not enter the gloves while you are
washing. The same vinyl gloves should be worn every time you are likely to get
your hands dirty (so that you do not have to wash then afterwards), or to
protect them from dust. When it is necessary to wash your hands, such as before
eating or after having used the toilet, it is necessary to use a “dry”
disinfectant. One possibility is an acqueous solution of benzalconium chloride
[8], which has a simultaneously cleansing and disinfecting action: soak some
cotton wool with the disinfectant, squeeze it to eliminate the excess liquid,
and then rub it on the hands

As far as the feet are concerned, put a stool in the
shower so that you can sit on it when washing the rest of your body while
keeping your feet out of contact with the water. You can then wash your feet in
the same way as your hands

Using natural reducing agents on palms and soles. It
is advisable to treat palmo-plantar psoriasis with the same natural reducing
agents as those described in the previous chapter. The agent should be applied
in the evening taking particular care to massage it in well because the
thickness of the stratum corneum on the palms and soles limits the absorption
of topical products to a minimum. If you use coal tar, you should wear light
cotton gloves or socks when sleeping in order to avoid staining the sheets, but
this is not necessary if you use one of the other agents.

Protect your
hands during the day.

During the course of the day, your hands come into
contact with various objects or substances that could aggravate the psoriasis,
and this has given rise to the idea of using something to protect the hands.
Although protective creams acts as stress factors on psoriatic skin and cannot
be applied, what have proved useful are ointments containing polyethylene
glycol (PEG) [9]. These ointments have the advantage that they form a barrier
between the skin and the external environment, but still allow the skin to
breathe. The suggested PEG ointment [8] also contains allantoin, a substance
that favours the cicatrisation of the fissuring, and can be applied a number of
times during the day.

When palmo-plantar psoriasis is in remission. Once the
remission of palmo-plantar psoriasis has been obtained, care needs to be taken
when handling potentially irritating substances in order to avoid
“re-awakening” the condition. The best suggestion is to continue wearing vinyl
gloves as necessary [7] and usiing lauryl sulphate-free cleansing cream [3]
instead of normal soap and shampoos.

Psoriasis
in the summer

In the summer, psoriasis tends to improve or
completely regress, mainly due to the effect of sunlight. However, it must be
borne in mind that not all forms of psoriasis improve with the sun, and that
some actually worsen. Nevertheless, it can be estimated that the sun is
beneficial in 80% of cases

The sun acts as an anti-psoriatic agent in various
ways: it increases the synthesis of vitamin D, which has an anti-psoriatic
action; decreases the rate of growth of the cells damaging DNA; and reduces
inflammation by distancing lymphocytes. It is probable that it also acts
against psoriasis by releasing some brain neurotransmitters – the same ones
that make us more good humoured.

The sun can therefore be considerd another natural
reducing agent. However
the same ultraviolet (UV) rays that are responsible for a large part of the
sun’s anti-psoriatic action are also the cause of skin cancers, and so it is
necessary to keep a balance between costs and benefits.
Finally, it is worth remembering that sunburn (i.e.
excessive exposure to the sun before beginning to acquire a tan) can
“re-awaken” psoriasis – and the same goes for exposure to a UV lamp.
It is therefore necessary not to get carried away by
the urge for a sun cure, but to take care when sunbathing – not least because sun protection creams and
lotions must be avoided.

Practical
advice
• Start sunbathing early in the season. UV rays are
effective as early as April, and it is more comfortable to stay in the sun
because the air is cooler
• Do not use sun protection creams or lotions, but take care not to get burnt
• If you are at the sea, take advantage of the action
of bathing in sea water
• If
necessary, use a natural reducing agent in the evening as a complement
• Remeber not to use coal tar because it is a
photosensitiser
• If your skin becomes dry, use a self-hydrating ointment [3] after showering
• Emollient Ointment – Extreme - [4] can also be used before going out into the sun as
it facilitates the penetration of UV rays
• Do not allow yourself to be conditioned by psoriasis, but also go sunbathing in the presence
of others.

Psoriasis
in a spa environment

Many spas, particularly those in Italy, have springs
of sulphurous thermal water in which the sulphur may be free or combined with
other substances. Various hydrological schools have classified sulphurous
waters in different ways. The Italian school identifies sulphurous waters as
those containing at least 1 mg of free H2S (1 hydrogen sulphide
degree 0.001 g, equal to 0.658 ml di H2S), and distinguishes:
• weak sulphurous waters: 1 - 10 mg/l of free H2S at 760 Torr;
• medium sulphurous waters: 11 - 100 mg/l of free H2S at 760 Torr;
• strong sulphurous waters: more than 100 mg/l of free H2S at 760 Torr.
The action of sulphur on the skin is thought to be due
to its interaction with the cysteine and its catabolites contained in
keratinocytes. After this reaction, the sulphur changes to hydrogen sulphide (H2S)
thus promoting keratinisation. At high concentrations, sulphur has a
keratolytic effect by setting under way the proteolysis of keratins via the
same hydrogen sulphide.
Sulphurous
water baths have been used since ancient times as a remedy for the various
types of psoriasis. Spas terme normally foresee a 10-minute sulphurous thermal
water bath in the morning, and freedom of sunshine or ultraviolet lamp therapy
as indicated by the on-site dermatologist. Positive results have been reported
in the majority of patients; however, it emerges from the various clinical
reports that the results of spa treatment appear from the fifteenth day
onwards. As the Italian National Health Service grants psoriatic patients 12
thermal baths and people generally now have less time to spend at spas, it can
be concluded that such treatment has been reduced to little more than a
complement.

In an attempt to strengthen spa therapy for psoriasis
we has recently proposed the following combined treatment:
• a 10-minute sulphurous water bath in the morning
• complete drying of the skin
• the application with massagge of vaseline-free evanescent sulphur salicylic cream [1] on the psoriatic areas
• a skin wash in the evening using a lauryl sulphate-free cleansing cream [3]
• the post-washing application of an Emollient Ointment –Extreme [4] with pickling activity.

The next day, the same treatment is repeated

In a study recentelly carried out, this treatment
regimen led to significantly better results after two weeks than treatment based
solely on the baths.

We also recommend this type of treatment for people who have the opportunity to
visit a spa. In the summer, this treatment can be complemented by heliotherapy,
but we personally do not recommend the use of UV lamps.

Despite some positive reports, the application of
muds, algae and hay does not seem to lead to substantial benefits in the
treatment of psoriasis.

Psoriasis
stress and society

How to feel at ease, and how to disguise psoriasis

Many people sustain that psoriasis is purely
psychosomatic; we think it is more correct to say that it is a disease that is
aggravated by stress but has different bases.

In any case, in the everyday experience of both
physicians and patients, there is a clear relationship between psoriasis and
stress. What should be considered is how much psoriasis induces stress in
patients, regardless of how much stress has influenced the onset of psoriasis.
If psoriasis generates stress, in addition to treating the skin, dermatologists
must try to attenuate the stress or the treatment will have no effect.

StressPsoriasisStressPsoriasis...

Unfortunately, everyday practice makes it all too plain
how difficult it is to attenuate the stress generated by psoriasis, and that
even recourse to anxiolytics or hypnogens often has no effect (as well as being
generally poorly accepted by patients).

The stress generated by society, work, the family, etc.
is even more unmanageable and, from this point of view, the picture is as
disappointing as it is worrying.

Luckily, given that any worsening is easily
perceptible, psoriatic patients are themselves well aware of the role of direct
or reflected stress in the genesis of their psoriasis.

Dermatologists must therefore remember and repeat
these concepts, and help their patients to reflect upon the need to seek all
possible and sustainable means of escaping stress.

How not to be
stressed by psoriasis

The rules are:
• Consider that psoriasis is not contagious
• Consider that psoriasis does not involve health
• Consider that psoriasis is very well known and does not shock people
• Consider that people look a lot but see very little
• Consider that psoriasis can regress at any time.

How to disguise
psoriasis

When visible, psoriasis becomes an aesthetically
displeasing sight that patients may not be able to tolerate. The most common case is psoriasis of the nails,
although it can be treated/disguised in many ways. The nail plate can be filed to eliminate the
distorsions and (partially) the stains; it can be covered with coloured or
opaque nail varnish; it can be hidden by a false resin nail.If the psoriasis affects the face, topical therapies
can be applied in the evening and, in the morning, make-up can be used to
eliminate the the erythematous nuance that makes it noticeable.

In
the case of scalp psoriasis, it can be suggested to keep your hair short, or
long but tied back, and to wear light-coloured clothing and not black or navy
blue.